Are You Forced to Call Consults?

[docB]

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Something Apollyon said in a different thread got me to thinking:

If there's no fracture, do you do a digital block before relocating them? I don't - I just tell them that there will be pain with a digital block while it's being placed, and there will be pain without it - each one is about 15 seconds.

What's your practice (as I assume you don't have ortho residents on-call to come down and put them back in)?

Thanks!

In my residency program we just did this kind of stuff (shoulders, hips, colles, fingers, etc.) but I have heard of programs where the ED is obligated by policy to call ortho for this stuff. Usually that kind of policy is justified under the "The specialty residents need the experience." type of argument and it's usually limited to smaller, lower volume places.

Is anyone training in that type of a system?

 

[EctopicFetus]

at the U of A we only called ortho for reductions we couldnt get / thought would be hard, or recent post op patients or patients with prosthesis (except hips).

Fingers, shoulders, hips. wrists, elbows etc.. all done in the ed by us.

I would say when i knew one of our interns was on I would call and ask if they were interested and wouldnt take forever getting down there.

We also called on all fx/dislocations.

 

[Greenbbs]

we don't have ortho residents at my joint.

Our ortho guys want to be called on all hip fx's, and anything we think is going to need surgical fixation. other than that, they're cool with our judgement and can see em in follow up.

our hand guys are pretty lickety split and if there's any question on anything, they'll be in asap to fix it. and they're fellowship trained hand guys. not plastics or ortho. kinda nice to have em around.

 

[Hawkeye Kid]

I don't think we have a policy, per se, but I've been at my academic job 7 months now and I honestly can't figure out for sure what the local standard is. For things that need f/u that I want our residents to do, we'll fix it and then call and ask who they (whoever "they" is often depends on day, week, phase of moon, etc) want the pt to f/u with. I specifically tell them that they only need to see the pt if they want to and that I don't need them to come down. Some of our faculty will call and say that they're D/Cing the pt in x minutes and they can see them if they're still in the ED when the residnet gets there; I haven't gone that far yet, but I can see how it would happen.

The kicker is that, apparently, plastics won't see someone in clinic unless their resident sees the pt in the ED. I can live with the pt being in the ED longer so the resident can get experience, and I can even tolerate it when they want x, y, or z additional test. But when the plastics resident gives me grief about reducing a MCP dislocation before calling him...

 

[Doctor Bob]

At my program we have to call the ortho attending before we do any reductions (except vascularly compromising fractures) to get their approval. I have yet to have an attending tell me to not do it.

I'm not sure why we have this policy... it seems like a rubber stamp. Maybe it's a throwback to when the hospital had ortho residents.

 

[pdp2001]

we call ortho for anything we've tried-failed to reduce, anything that may need surgical fixation after reduction (we usually reduce them first, esp if there's neurovasc compromise), and to give them a heads up on patients who will see ortho outpt but don't need to be seen. for the most part, our ortho residents are pretty good about letting us have another shot at the complex reductions/failed reductions once they're down there to lend a hand (some of their tricks are awesome).

 

[GoBuckeyes913]

We have to call ortho for almost everything, and whether or not the ortho residents come down vs. ED doc or resident taking care of the situation is ortho attending dependent. Our ortho residents get plenty of experience, so usually run-of-the-mill dislocations and reductions are done by ED, but we still gotta call.